The economic impact of Mexico City's smoke-free law

Barriers and opportunities for improving smoke-free area implementation in Banda Aceh city, Indonesia: a qualitative study

OBJECTIVES

To investigate the challenges and opportunities for implementing smoke-free areas (SFAs) within eight area categories using the WHO Framework Convention on Tobacco Control as a framework for analysis.

DESIGN

This study used qualitative methods (in-depth interviews and document reviews). All transcripts from the interviews and formal documents were coded using NVivo V.11 software and analysed using an inductive thematic analysis.

SETTING

Banda Aceh, Indonesia.

PARTICIPANTS

Seventy-three participants were interviewed, stratified by ages (18-59 years): policymakers (n=4), SFA implementers (n=33), SFA's non-compliance prosecutors (n=2), SFA observers (n=4), communities/respected figures (n=30); and 10 documents were reviewed.

RESULTS

Barriers to the effective implementation of SFAs were identified: conflict of interests of Banda Aceh authorities in implementing SFA policies; inadequate monitoring, evaluation and implementation of SFAs among involved actors; inadequate public communication of SFAs to communities; and misunderstanding of 'enclosed areas' as SFAs. However, some important opportunities were identified: the Ministry of Education promotes SFA at schools; and smoking prohibition as part of sharia and other religions' recommendations.

CONCLUSIONS

This research is the first study to examine SFAs to understand the challenges and opportunities for improving SFA policy implementation by interviewing various key respondents in Banda Aceh (religious leaders and respected figures). These key stakeholders' roles are crucial to enhance the implementation of SFA policies in Banda Aceh (currently suboptimal) and other populous Muslim areas in Indonesia or other countries because smoking contradicts Islamic teachings and other religions' tenets. Further, the findings propose policymakers and involved agencies strengthen public communication, execution, monitoring and evaluation, and enforcement of SFA policies in Aceh. Finally, the application of methods and results from this study to other local areas in Indonesia or other developing nations is necessary to facilitate further understanding more about the applicability, advantages and limitations of this study.

Taxation of tobacco, alcohol, and sugar-sweetened beverages: reviewing the evidence and dispelling the myths

The article reviews the large body of evidence on how taxation affects the consumption of tobacco, alcohol, and sugar-sweetened beverages (SSB). There is abundant evidence that demand for tobacco, alcohol, and SSB is price-responsive and that tax changes are quickly passed on to consumers. This suggests that taxes can be highly effective in changing consumption and reducing the burden of diseases associated with consuming these products. Tobacco, alcohol, and SSB industries oppose taxation on similar grounds, mostly on the regressivity of taxes since regressive taxes take a larger percentage of income from low income earners than from middle and high income earners; but also on the effects taxes might have on employment and economic activity; and, in the case of tobacco, the effects taxation has on illicit trade.Contrary to industry arguments, evidence shows that taxation may have short-term negative financial consequences for low-income households. However, medium and long-term financial benefits from reduced healthcare costs, better health, and welfare largely compensate for such consequences. Moreover, taxation does not negatively affect aggregate economic activity or employment, as consumers switch demand to other products that generate employment and may compensate for any employment loss in taxed sectors. Evidence also shows the revenues generated are generally spent on labour-intensive services. In the case of illicit trade in tobacco, evidence shows that illicit trade has not increased globally (rather the opposite) despite increases in tobacco taxes. Profit-maximising smugglers increase illicit cigarette prices along with the increases in licit cigarette prices. This implies that even when increased taxes divert some demand to the illicit market, they push prices up in the illicit market, discouraging consumption.

Smoke-free spaces: a decade of progress, a need for more?

Adoption of smoke-free measures has been one of the central elements of tobacco control activity over the past 30 years. The past decade has seen an increasing number of countries and proportion of the global population covered by smoke-free policies to some extent. Despite reductions in global smoking prevalence, population growth means that the number of non-smokers exposed to the harms caused by secondhand smoke remains high. Smoke-free policy measures have been shown to be useful in protecting non-smokers from secondhand smoke, and can additionally increase cessation and reduce smoking initiation. Policies tend to be aimed primarily at enclosed public or workplace settings with very few countries attempting to control exposure in private or semiprivate spaces such as homes and cars, and, as a result, children may be benefiting less from smoke-free measures than adults. Compliance with legislation also varies by country and there is a need for education and empowerment together with guidance and changing social norms to help deliver the full benefits that smoke-free spaces can bring. Restrictions and policies on use of electronic cigarettes (e-cigarettes) in smoke-free settings require more research to determine the benefits and implications of bystanders' exposure to secondhand e-cigarette aerosol, dual use and smoking cessation.

Implementing smoke-free policies in low- and middle-income countries: A brief review and research agenda

INTRODUCTION

Some low- and middle-income countries (LMICs) struggle to implement smoke-free policies. We sought to review the academic and gray literature, and propose a research agenda to improve implementation of smoke-free policies and make them more effective in LMICs.

METHODS

We reviewed 10 databases for variations of (‘implementation’ /‘enforcement’ /‘compliance’) and (‘smoke-free’ /‘ban’ /‘restriction’) and (‘tobacco’ /‘smoking’). We also reviewed cited sources and the gray literature including non-governmental organization reports.

We included articles that described problems that arose, attempted solutions, lessons learned, and research questions posed regarding smoke-free policy implementation in LMICs. We excluded studies of high-income countries, institution-level implementation, voluntary smoke-free policies, smoke-free homes, and outdoor smoke-free policies.

RESULTS

The academic literature review led to 4931 unique articles, reduced to 1541 after title screening, 331 after abstract screening, and 101 after full-text review. The citation and gray literature review led to an additional 179 publications of which 67 met the inclusion criteria. In total we retained 168 sources. We conducted a narrative review and synthesis of the literature, extracting key themes and noting research gaps.

CONCLUSIONS

We find that progress is urgently needed in five categories: identifying the critical lessons learned for effective implementation, evaluating different enforcement approaches, learning how to rejuvenate stalled smoke-free policies, learning how to increase ground-level will to enforce policies, and developing a conceptual framework that explains implementation. Investigation into these topics can improve implementation of smoke-free policies in LMICs.

Disability-Adjusted Life Years for Cancer in 2010⁻2014: A Regional Approach in Mexico

The disability-adjusted life years (DALYs) were used to estimate the regional (state of Colima, Mexico) cancer burden in 2010⁻2014. The years of life lost (YLL) were estimated with mortality data and years lived with disability (YLD) using incidence data. The DALYs were calculated as the arithmetic addition of YLL and YLD. Sex and cancer site-specific estimations were made and DALY rates were used to identify the leading causes of disease burden. Data from 2532 deaths were analyzed and, for all malignant tumors combined, 18,712.9 DALYs and 20,243.3 DALYs were estimated in males and females respectively. The overall contribution of YLL in DALY estimates was higher among females (93.7% vs. 87.4%). Age-standardized DALY rates (and 95% confidence intervals, CI) per 100,000 inhabitants were used to rank the leading causes of disease burden and, among males, malignant tumors from the prostate, lower respiratory tract, and colon and rectum accounted the highest rates (45.7, 95% CI 32.7⁻59.3; 37.6, 95% CI 25.7⁻49.9; and 25.9, 95% CI 16.0⁻36.1 DALYs). Breast, cervix uteri, and lower respiratory tract cancer showed the highest burden in females (66.0, 95% CI 50.3⁻82.4; 44.4, 95% CI 31.5⁻57.7; and 20.9, 95% CI 12.0⁻30.0 DALYs). The present study provides an indication of the burden of cancer at the regional level, underscoring the need to expand cancer prevention, screening, and awareness programs, as well as to improve early diagnosis and medical treatment.

Social Inequalities in Secondhand Smoke Among Japanese Non-smokers: A Cross-Sectional Study

BACKGROUND

Secondhand smoke (SHS) causes many deaths. Inequalities in SHS have been reported in several countries; however, the evidence in Asian countries is scarce. We aimed to investigate the association between socioeconomic status (SES) and SHS at home and the workplace/school among non-smoking Japanese adults.

METHODS

Cross-sectional data from the Miyagi Prefectural Health Survey 2014 were analyzed. Self-reported questionnaires were randomly distributed to residents ≥20 years of age and 2,443 (92.8%) responded. The data of the 1,738 and 1,003 respondents were included to the analyses for SHS in the past month at home and at the workplace/school, respectively. Ordered logistic regression models considering possible confounders, including knowledge of the adverse health effects of tobacco, were applied.

RESULTS

The prevalence of SHS at home and the workplace/school was 19.0% and 39.0%, respectively. Compared with ≥13 years of education, odds ratios (ORs) and 95% confidence intervals (CIs) for SHS at home were 1.94 (95% CI, 1.42-2.64) for 10-12 years and 3.00 (95% CI, 1.95-4.60) for ≤9 years; those for SHS at the workplace/school were 1.80 (95% CI, 1.36-2.39) and 3.82 (95% CI, 2.29-6.36), respectively. Knowledge of the adverse health effects of tobacco was significantly associated with lower SHS at home (OR 0.95; 95% CI, 0.91-0.98) but it was not associated with SHS at the workplace/school (OR 1.02; 95% CI, 0.98-1.06).

CONCLUSIONS

Social inequalities in SHS existed among Japanese non-smoking adults. Knowledge about tobacco was negatively associated with SHS at home but not at workplace/school.

Media coverage of smoke-free policies after their innovation

Smoke-free policies are critical to global tobacco control, and prior research on media coverage of smoke-free policies primarily focused on the period when they were first innovated; however, the scientific basis for smoke-free policies has broadened, and how media coverage has changed, if at all, is unknown. The authors characterized the actors, arguments, and favorability of media coverage of smoke-free policies from 2006 to 2009, by content-analyzing 452 news stories in the 4 primary newspapers in South Carolina. Most media coverage was favorable (45%) or mixed (43%) toward smoke-free policies, and negative coverage decreased over time (B = -1.001, SE = 0.326; p = .008). The most prevalent argument concerned the harms of secondhand smoke (44%). A higher percentage of articles mentioned economic arguments against (26%) than for (17%) smoke-free policies (χ(2) = 10.89, p < .01, for the difference between 26% and 17%), and these percentages did not change over time. Advocates and media should improve communications to more effectively represent scientific evidence regarding the null or positive impact of smoke-free policies on businesses.

Impact of the Irish smoking ban on sales in bars using a large business-level data set from 1999 to 2007

BACKGROUND

Ireland introduced comprehensive smoke-free workplace legislation in 2004. This study evaluates the economic impact of the workplace smoking ban on the value of sales in bars.

METHODS

Data on the value of bar sales were derived from a large, nationally representative, annual business-level survey from 1999 to 2007. The economic impact of the smoking ban was evaluated according to geographical region and bar size. Analysis was based on an econometric model which controlled for background changes in population income and wealth and for investments made by the bars during this period.

RESULTS

The overall impact of the Irish smoking ban on bar sales appears to be very small. The ban was associated with an increase in sales among medium to large bars in the Border-Midland-West (more rural) region of Ireland, and a small reduction in sales among large bars in the more urban, South-East region. We failed to find any evidence of a change in bar sales in the remaining categories studied.

CONCLUSIONS

The results indicate that although some bars saw positive effects and some negative, the overall impact of the smoking ban on the value of sales in bars was negligible. These findings provide further supporting evidence that comprehensive smoke-free workplace legislation does not harm hospitality businesses while having positive health effects.

Protecting the world from secondhand tobacco smoke exposure: where do we stand and where do we go from here?

INTRODUCTION

Article 8 of the Framework Convention on Tobacco Control mandates all signatory countries to "protect citizens from exposure to tobacco smoke in workplaces, public transport and indoor public places." Even though there has been great progress in the implementation of Article 8, still most of the world population remains exposed to secondhand smoke (SHS). In this article, we sought to summarize the research that supports Article 8, where do we stand, and current research gaps and future directions.

DISCUSSION

Secondhand smoke is an established cause of heart disease and several types of cancer. Additional research is needed to reach final conclusions for diseases where evidence is only suggestive of causality. The only solution to SHS exposure in public places is banning smoking indoors. Research on the gaming industry and nightclubs, particularly in developing countries, needs to be disseminated to support their inclusion in smoke-free laws. Aside from indoor bans, additional research is needed for outdoor and multiunit housing bans and in support of measures that protect children and other vulnerable populations. The impact of smoke-free laws on other health outcomes, besides heart disease and respiratory outcomes, is another area where further research is needed. Thirdhand smoke assessment and health effects are also likely to be a topic of further research. As new tobacco products emerge, evaluating SHS exposure and effects will be vital.

CONCLUSIONS

Furthering research in support of Article 8 can contribute to reach the final goal of protecting everyone from SHS exposure.

Smokefree policies in Latin America and the Caribbean: making progress

We reviewed the adoption and implementation of smokefree policies in all Latin American and the Caribbean (LAC) countries. Significant progress has been achieved among LAC countries since the WHO Framework Convention on Tobacco Control (FCTC) was adopted in 2005. Both national and sub-national legislation have provided effective mechanisms to increase the fraction of the population protected from secondhand tobacco smoke. Civil society has actively promoted these policies and played a main role in enacting them and monitoring their enforcement. The tobacco industry, while continuing to oppose the approval and regulation of the laws at legislative and executive levels, has gone a step further by litigating against them in the Courts. As in the US and elsewhere, this litigation has failed to stop the legislation.